Credit Application / Truclean

Company Information

Trading Name *

Company Name *

Business Street Address *

Business Suburb Address *

Business State Address *

Business Postcode Address

Is the postal address the same as the business address? *

Postal Street Address

Postal Suburb Address

Postal State Address

Postal Postcode Address

ABN Number

Phone *

Email *

Fax

Contact Information

Account Contact Name *

Account Contact Phone *

Account Contact Email *

Director/Owner Full Name *

Director/Owner Street Address *

Director/Owner Suburb Address *

Director/Owner State Address *

Director/Owner Postcode Address

Director/Owner Phone *

Director/Owner Email *

Second Director/Owner Full Name

Second Director/Owner Street Address

Second Director/Owner Suburb Address

Second Director/Owner State Address

Second Director/Owner Postcode Address

Second Director/Owner Phone

Second Director/Owner Email

Trade References

Trade Reference Name

Trade Reference Phone

Trade Reference Email

Second Trade Reference Name

Second Trade Reference Phone

Second Trade Reference Email

Third Trade Reference Name

Third Trade Reference Phone

Third Trade Reference Email

Final Details

Applicant Name *

Applicant Position *

Terms *

I hereby apply to initiate a credit account with TRUCLEAN (QLD) PTY LTD. Our trading terms are 30 days from the date of the invoice. Accounts owing beyond 60 days will be placed on immediate stop supply. I agree to abide by their trading terms (ie 30 days as of date of invoice) as established.

Equipment *

Do you agree that the loan equipment remains the property of TRUCLEAN (QLD) PTY LTD?